NHS in crisis for the last 20 years
We love our NHS in the UK. She provides patient care. She’s big, expensive and nobody really knows how it all works. But, work it does and I challenge you to find any Brit whose insides don’t fill to the brim with warm fuzzy pride at the first glimpse of NHS blue (ahem, pantone 300 in case you’re wondering).
You also won’t be surprised to know that the NHS is in crisis – a seemingly popular headline news story every year, for the last 20 years.
What crisis? I hear you ask. Put simply, we have an aging population, an increased prevalence of patients with long term conditions and a decreasing budget to manage them.
Fighting back to full health
So, our NHS is on a journey to get fighting-fit for the modern era of patient care. A fitness regime that will see it eat its greens, get lean and pump those pantone 300 muscles.
Training day 1, it’s 5am on Monday morning and with a healthy smoothie in-hand (probably containing some trendy seeds), it’s time to put together a rigorous training programme – go NHS.
The training programme: Five Year Forward View, Lord Carter’s review in NHS productivity and the eProcurement strategy (to name just a few).
“Our NHS is on a journey to get fighting-fit for the modern era of patient care.”
In the interest of improving the information flow between healthcare suppliers and hospitals, and getting it to where it can add most value – into the patient pathway – let’s look at where we are today with the Department of Health’s eProcurement strategy, relabelled by many as the Scan4Safety programme (there is even a Scan4Safety website).
By now, we know this strategy by-heart: every product and service procured by every NHS hospital will be uniquely identified using GS1 barcoding standards and transacted electronically using the PEPPOL electronic messaging standard – sounds simple enough.
Why isn’t everyone doing it yet?
But, surely such a paradigm shift for the NHS can’t simply mean barcodes and e-commerce? Surely not, I mean that all sounds very archaic in a world of Artificial Intelligence, Uber and Google Glass, right?
Yes yes, but barcoding is CHEAP, easy to adopt and effective. And, the benefits of e-commerce are just plain obvious. This is exactly what the NHS likes to hear (it’s spent all the budget on expensive chia seed smoothies).
So, CHEAP, easy to adopt and effective you say? Why isn’t everyone doing it yet?
Well, put simply any new strategy takes time to adopt – especially with the scale of transformational change the NHS is seeking to achieve. But, why hasn’t wide-scale adoption been quicker?
“Barcoding is CHEAP, easy to adopt and effective. And, the benefits of e-commerce are just plain obvious.”
The adoption gap
There is a clever thing called the technology adoption lifecycle that describes the adoption of a new product or innovation.
Think of it this way, when Apple release a new iPhone, we all have that one friend who marches down to Apple’s flagship store in London two days before the launch with a sleeping bag under their arm and a flask of hot chocolate because they ABSOLUTELY MUST have it NOW (geeky phone friend is an ‘innovator’ and they’ll happily go through the pain of new iOS bugs just to have the latest gadget). Now think of your great aunty Doreen who has just about fathomed how to set up a ‘Whatsapp group’ (Aunty Doreen is a ‘laggard’).
Between these two extremes is mass adoption. Sometimes innovation and early adoption don’t progress seamlessly into mass-adoption and this is known as an adoption gap. We’re seeing this to a degree in the PEPPOL and GS1 adoption ‘Scan4Safety’ programme.
Adoption by NHS trusts
- 2014 – the Department of Health mandated the eProcurement Strategy.
- 2015 – six NHS trusts – with varied number of beds, financial stability and existing level of readiness – were chosen to demonstrate the benefits of PEPPOL and GS1 adoption in a real-life hospital setting.
- 2016 – six NHS trusts began a two-year demonstration period.
- 2017 – even before the demonstration plan has been fully implemented, each of the six demonstration NHS trusts are reporting improvements in patient safety, true patient-level-costing, better stock visibility and returns on investment (or a combination of these).
There are 154 acute NHS trusts in England (these are the trusts who are expected to embrace PEPPOL and GS1 first), yet only six are embracing with vigour. There are other trusts moving too, choosing PEPPOL access points and using barcodes in the shadows just like stealthy ninjas, but it’s not the wholesale hustle that we were expecting.
The super six Scan4Safety trusts are innovators and with this we must accept that their job is to learn, discover and overcome the teething problems and hick-ups, that come with being first to the party, to pave the way for future fellow adopters (this is the same for suppliers who began implementation first). Paving the way, it seems, is slow business and everybody is wondering when the next group of trusts will turn up to the party.
“There are 154 acute NHS trusts in England, yet only six are embracing with vigour.”
Adoption by suppliers
Suppliers are now arguably more advanced than the NHS in terms of wide-scale adoption, but this wasn’t always the case. At first, the Department of Health’s eProcurement strategy was taken with a pinch of salt. After all, we’ve seen these efficiency and modernisation programmes rise and fall with the tides time and again – so why would a savvy healthcare supplier invest today in something that just might be long forgotten by tea time tomorrow?
Investing £12m in the six demonstrator NHS trusts was a statement of commitment by the Department of Health that said, “we’re serious about this programme”. Since then, we’ve seen the contact terms and conditions updated twice to include increasingly rigorous contractual obligations to both providers and suppliers – this is the Department of Health letting us know that, “we’re serious about this” and “this strategy isn’t going away”.
This, along with the hard work of the Scan4Safety trusts in engaging their suppliers directly, has seen supplier adoption increase exponentially. The early innovators are well on their journeys with early adopters hot on their tails – but, where are the early majority? Waiting, waiting, waiting – don’t they know how great PEPPOL is?
There are thousands of suppliers into the NHS. Thousands. But, only a few hundreds have submitted statements of commitment and self-declarations to say, “we’re taking this seriously”.
The heritage of Governmental strategies falling off a cliff never to be seen again has stifled adoption for sure. This has led to a great deal of suppliers ‘sat on the fence’ about whether to invest in PEPPOL and GS1 adoption, waiting for it to ‘go away’. Recently, more and more suppliers are getting off the proverbial fence to invest in their own PEPPOL and GS1 adoption programmes. A likely consequence of re-enforcement from the Department of Health in the guise of events, public statements and NHS contract updates, determination from the NHS Scan4Safety trusts in proving their own adoption programmes and the fact that the strategy is still alive and well three years and counting after its initial publication.
“Recently, more and more suppliers are getting off the proverbial fence to invest in their own PEPPOL and GS1 adoption programmes.”
Tackling the adoption gap
The benefits of PEPPOL and GS1 adoption are already being proved in trusts and suppliers – so we know it adds real value in real life healthcare provider and supplier settings.
But, why haven’t we seen wider adoption? I mean, if it works then it works – let’s get everyone doing it.
Actually, the programme is (ahem) on-track. The strategy was launched, six NHS trusts embarked on a two-year journey to prove it works and we’re nearly at the end of that journey. Next, everyone is eagerly anticipating an announcement that another group of trusts will be tasked (funded?) to follow the template the Scan4Safety six have been crafting for two years. We’re additionally seeing trusts go at it alone to roll out PEPPOL and GS1 adoption without the over-watching eye of the Department of Health – the fact is, there is real value in adoption with or without central funding. Funding of course helps to speed up adoption.
“More trusts acting in a in a standardised way means greater economies of scale and a faster return on their investment.”
There’s no doubt suppliers are supportive of the benefits the strategy brings to the NHS ecosystem (this includes patients, trusts and suppliers) – improved patient safety, enhanced clinical effectiveness and operational efficiencies. However, suppliers have been dubious about whether the programme will stick around long enough for them to see a benefit. But, now we know it’s not going anywhere and we are witnessing clear positive momentum in the direction of PEPPOL and GS1 adoption.
It’s the group known as the early majority that will be the tipping point for wide-scale adoption. Why? Because all the hard work has been done by the innovators and early adopters, leaving the next group to join the party with ‘relative’ ease – following the footprints of those who painstakingly went through it first. And, there are large numbers of suppliers in this category, waiting for the path to be laid before taking to their own programmes. So, why is there still a gap between those that have adopted and those that haven’t yet?
For suppliers, bridging the gap from early adopter to early majority means one thing, more NHS trusts please. More NHS trusts using PEPPOL and GS1 standards will drive more suppliers to adopt. Put simply, more trusts acting in a in a standardised way means greater economies of scale and a faster return on their investment.
By adopting PEPPOL and GS1 standards, suppliers can reap the rewards of achieving their own efficiencies with greater price and stock visibility. This in turn will reduce the overall cost of doing business with the NHS, delivering a tangible return on investment and additionally delivering enhanced regulatory compliance – which is especially important in healthcare (after patient safety of course).